Prevalence and prognostic role of untreated moderate-to-severe tricuspid regurgitation: a systematic review and meta-analysis

AIM: We aimed to assess the prognostic role of untreated moderate-to-severe tricuspid regurgitation (TR) by a systematic review and meta-analysis. METHODS: We searched Pubmed from database inception to 14 August 2025. Studies reporting data on clinical outcomes associated with different TR grades not receiving treatment were considered eligible. The primary endpoint was all-cause mortality; secondary endpoints included cardiovascular (CV) mortality and heart failure (HF) hospitalization. Pooled estimates were calculated using random-effects models. RESULTS: Our literature search yielded 2,727 articles, of which 225 were assessed for full-text eligibility. A total of 106 studies (107 comparisons) comprising 961,136 patients, were included in the quantitative synthesis. The overall prevalence of untreated moderate-to-severe TR was 13.5%, but varied widely across population subgroups. Moderate-to-severe TR was associated with a significantly higher all-cause mortality compared with none-to-mild TR (unadjusted HR 2.07; 95% CI 1.89-2.26; p < 0.001). The association was confirmed in adjusted models and among different subgroups (i.e., patients performing a general echocardiographic irrespective of indication, patients with left-side valvular heart disease [LSVHD], HF without LSVHD, patients undergoing cardiac implantable electronic device implantation, left ventricular assist device recipients and in patients with pulmonary artery hypertension), but not after heart transplantation. A stepwise increase in mortality was observed with increasing TR severity. Moderate-to-severe TR was also associated with higher risk of CV mortality and HF hospitalization (HR 1.92 [1.64-2.26] and HR 1.63[1.44-1.84], respectively). CONCLUSION: Untreated moderate-to-severe TR is associated with higher risk of all-cause mortality, CV mortality and HF hospitalization, underlying the role of timely diagnosis and appropriate management.